Received: 13 March 2014; in revised form: 30 April 2014 / Accepted: 28 May 2014 / Published: 5 June 2014
ABSTRACT:
In industrial societies, women increasingly postpone motherhood. While men do not fear a loss of fertility with age, women face the biological boundary of menopause. The freezing of unfertilized eggs can overcome this biological barrier. Due to technical improvements in vitrification, so-called “social freezing” (SF) for healthy women is likely to develop into clinical routine. Controversial ethical debates focus on the risks of the technique for mother and child, the scope of reproductive autonomy, and the medicalization of reproduction. Some criticize the use of the technique in healthy women in general, while others support a legally defined maximum age for women at the time of an embryo transfer after oocyte cryopreservation. Since this represents a serious encroachment on the reproductive autonomy of the affected women, the reasons for and against must be carefully examined. We analyze arguments for and against SF from a gendered ethical perspective. We show that the risk of the cryopreservation of oocytes for mother and future child is minimal and that the autonomy of the women involved is not compromised. The negative ethical evaluation of postponed motherhood is partly due to a biased approach highlighting only the medical risks for the female body without recognizing the potential positive effects for the women involved. In critical accounts, age is associated in an undifferentiated way with morbidity and psychological instability and is thus used in a discriminatory way. We come to the conclusion that age as a predictor of risk in the debate about SF is, from an ethical point of view, an empty concept based on gender stereotypes and discriminatory connotations of aging. A ban on postponing motherhood via SF is not justified.
CONCLUSIONS:
In our paper, we have examined whether it is ethically justified to prohibit SF in principle, or at least for women above a certain age limit. We have critically examined empirical data and ethical arguments for and against SF. We inquired into the risk and benefits of the technique for the mother and the child. We also addressed whether women’s capacity for self-determination is compromised by social factors and whether SF is the wrong technological answer to what is in fact a social problem. With regard to SF, is it true that, as Karey Harwood holds, “technological solutions to social problems are inadequate and often result in the further oppression of disadvantaged groups” [67]?
Our study has shown that existing data indicate that the process does not entail any significant increase in the risk of a malformation in the child. It also follows from our evaluation that even though the risk of morbidity and mortality in a later pregnancy is increased for the woman, the level of interindividual differences is large. However, further follow-up studies are needed. Yet, as Mertes and Pennings rightly summarize, the procedure of SF itself does not represent a significant danger. The danger is instead that women learn too late of its existence and that as a result their eggs are already aged at the time of freezing [74]. Instead, as Goold and Savulescu stress, the positive aspects of late motherhood like equal participation by women in employment, more time to choose a partner, better financial opportunities for the child and a reduction of genetic risks have to be taken into account [78].
Against the self-determined decision of women in favor of SF, it is argued that women are pressed into making the decision by social conditions and hence are not in a position to decide autonomously. However, even if social expectations attached to the woman’s role play a contributory role in the decision to opt for SF, this is not sufficient to justify a paternalistic prohibition of the technology. Reproductive decisions are not generally taken in a vacuum, but are specifically characterized by the fact that they situate the person concerned in a social context shaped by traditions and expectations. This holds true for women and men alike. The resulting social pressure should not be counteracted by restricting the scope for making decisions. Instead, the decision for or against this technique should be facilitated through information. Anyone who asserts that this technique unnecessarily medicalizes reproduction would have to explain what is intrinsically bad about availing of SF. For the points of criticism adduced in this context concerning elevated risk or meagre utility are not so emphatic that they alone could justify a general prohibition. In a pervasively technologized world, the ideal of natural reproduction can count at best as a personal preference, but not as a moral principle valid for everyone ([88], p. 146).
Critics of SF have argued further that women would postpone having children for selfish reasons and that postponing childbirth represses the fact of the finitude of human life [16,85]. However, this is a sweeping judgment associated with a stereotypical denigration of women’s motives. According to empirical findings, women who fulfill their desire to have children at a relatively advanced age are not a homogeneous group and act on different motives. Though, even an egoistic decision is not per se reprehensible on ethical grounds as long others are not harmed as a result. The desire to procreate and to have a biological child of one’s own is a potentially important element of individual conceptions of life and should be recognized as such.
Thus far, therefore, no cogent arguments have been put forward for a fundamental prohibition of SF. So, are there sufficient reasons for a legally stipulated limit on the age of the woman at the time of the implantation of the embryo in order to prevent women from using this technique at an advanced age? Late pregnancy is in fact associated with increased risks for the woman. However, these vary between individuals and are not generally higher than in the case of other medical interventions in which people are considered to be capable of making an informed decision, such as a sterilization operation. Another reason to limit the age of women would be the risk for the child to be orphaned at a young age [59–61]. This argument from the debate about postmenopausal motherhood has some merit ([89], p. 33). However, as Goold puts it: “If we really thought that having one older parent was problematic, aging men conceiving children with younger women would have received greater censure” ([89], p. 34). Age limits for the reproduction of either men or women should comply with the requirements of justice and reproductive equality. For both men and women, conditions like having a younger partner should be taken into account. This would encourage a case-by-case decision rather than a fixed age limit as Goold in fact proposes ([89], p. 34).
In the debate over late motherhood, a particularly critical view is taken of the risks for the woman and the child. Comparable risks for the child that may result from the advanced age of the father at the time of conception, by contrast, seldom receive mention (e.g., [90,91]) and at any rate are not grounds for a prohibition on late fatherhood. In any case, the proven protective and generally positive aspects of late parenthood should not be overlooked. For little can be deduced from chronological age alone concerning a person’s physical and psychological well-being. In fact, disease, physical fitness, social networking, stable partnership, and life situation play a crucial role in the incidence of complications. Instead, however, when it comes to late motherhood, age is associated in critical accounts in an undifferentiated way with morbidity and psychological instability and is thus used in a discriminatory way. A straightforward medical and ethical evaluation of late motherhood that takes a homogeneous group of “old women” as its point of departure does not do justice to individual variations in life situations. In this respect, age as a predictor of risk in the debate about SF is, from an ethical point of view, an empty concept based on gender stereotypes and discriminatory connotations of aging. Therefore, legal limits for the age of implantation of embryos following oocyte cryopreservation should not be stipulated either.
?Translated by Ciaran Cronin for SocioTrans—Social Science Translation & Editing Services. We
?are grateful to three anonymous reviewers.
The research presented in this paper is part of Stephanie Bernstein’s dissertation on the ethics of “social freezing” under the supervision of Claudia Wiesemann. Both authors were involved in developing the concept of the paper, writing, and revising it.
Arizona Center for Fertility Studies strongly supports SF (social freezing) and egg vitrification for women of any age that want to preserve their future fertility till the “time is right”. Please feel free to contact us at any time with questions.
